Provider Demographics
NPI:1992229280
Name:J C LEWIS PRIMARY HEALTH CARE CENTER INC
Entity type:Organization
Organization Name:J C LEWIS PRIMARY HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-495-8887
Mailing Address - Street 1:PO BOX 13577
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0577
Mailing Address - Country:US
Mailing Address - Phone:912-495-8887
Mailing Address - Fax:912-233-2057
Practice Address - Street 1:5 MALL ANX
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4738
Practice Address - Country:US
Practice Address - Phone:912-721-6705
Practice Address - Fax:912-233-2057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J C LEWIS PRIMARY HEALTHCARE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-28
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)